Nutritional status of outpatients with systemic immunoglobulin light-chain amyloidosis

Background: Maintenance of a good nutritional status is associated with prolonged survival in many chronic diseases. To date, the nutritional status of outpatients with immunoglobulin light-chain (AL) amyloidosis has not been evaluated. Objective: The aims of this study were to obtain information regarding the nutritional status of AL amyloidosis outpatients and to investigate its prognostic role. Design: One hundred six consecutive patients with histologically confirmed AL amyloidosis were enrolled. Anthropometric, biochemical, and clinical variables were measured. The Kaplan-Meier method was used to calculate survival. A Cox proportional hazard model was constructed to evaluate the prognostic effect of the nutritional variables. Results: Unintentional weight loss (median: 11.3%; range: 2.6– 34% of usual nonedematous body weight) was documented in 58 subjects (54.7%). Body mass index (BMI; in kg/m2) was 22 in 25 subjects (23.6%). Serum prealbumin was 200 mg/L (lower reference limit) in 26 patients (24.5%). A multivariate analysis showed that the percentage weight loss was significantly greater in patients with than in those without cardiac involvement (P0.03), and it also differed significantly by New York Heart Association class (P 0.02) and Eastern Cooperative Oncology Group performance status (P 0.001). Cardiac involvement (P 0.008), hematologic response to therapy (P 0.013), BMI (P 0.001) and serum prealbumin (P 0.001) were independent predictors of survival. Conclusions: Malnutrition is a prominent clinical feature of patients with AL amyloidosis. Appropriate nutritional evaluation that comprises the easily measurable nutritional variables associated with survival should be an integral part of the clinical assessment of AL amyloidosis outpatients.